Pyrimethamine pregnancy

Hypersensitivity to sulfonamides or chemically related drugs (eg, sulfonylureas, thiazide and loop diuretics, carbonic anhydrase inhibitors, sunscreens with PABA, local anesthetics) pregnancy at term lactation infants less than 2 months of age (except in congenital toxoplasmosis as adjunct with pyrimethamine) porphyria salicylate hypersensitivity. 

Folate deficiency can be dietary, especially in the eiderly, due to increased demand like in pregnancy, or due to maiabsorption syndromes. Agents which can cause folic acid deficiency with long-term use include phenytoin, oral contraceptives, isoniazid and glucocorticosteroids. In rare instances the use of dihydrofolate reductase inhibitors like trimethoprim, methotrexate or pyrimethamine can contribute to the occurrence of folate deficiency. Folinic acid can circumvent the need for the inhibited dihydrofolate reductase. 

Sulfonamides are contraindicated in patients with known hypersensitivity or intolerance to any member of this drug femily. Sulfonamides are also contraindicated in pregnancy at term, for nursing mothers, and for infants less than 2 months old becanse they can promote kernicterus in the newborn by displacing bilirubin from plasma proteins. The sulfonamides, pyrimethamine, and trimethoprim are contraindicated in patients with documented blood dyscrasias. 

Asymptomatic or uncomplicated primary infection requires no treatment. Severe courses of disease are treated with pyrimethamine (50 mg/day for approx. 2 weeks, followed by 25 mg/day for approx. 2 weeks) or sulphamethoxydiazine (50 mg for day 1, 25 mg as from day 2 or 3) -t pyrimethamine (100 mg/kg BW/day) or clindamycin -i- pyrimethamine. As an alternative approach (e.g. in the first trimester of pregnancy), spiramycin may be given. In order to reduce the myelotoxicity of pyrimethamine, the administration of folic acid (10-15 mg/day) is recommended. 

A review of the use of mefloquine in pregnancy (47) did not suggest that mefloquine has a worse effect in pregnancy than other antimalarial drugs, such as chloroquine and pyrimethamine + sulfadoxine. 

Sulfonamide and/or pyrimethamine sensitivity, pregnancy, and G6PD deficiency are contraindications. Use in young infants is considered inadvisable the history of an 8-month-old infant with P. falciparum malaria who developed high fever, tachycardia, hypotension, chills, jaundice, and splenomegaly 48 hours after a single parenteral dose of Fansidar (pyrimethamine + sulfadoxine) (SEDA-16, 309) seems to confirm the wisdom of this advice. It has been advocated that Fansidar should not be used prophylactically if exposure to malaria will last less then 3 weeks, in view of the incidence of severe skin reactions during the first month. 

Deen JL, von Seidlein L, Pinder M, Walraven GE, Greenwood BM. The safety of the combination artesunate and pyrimethamine-sulfadoxine given during pregnancy. Trans R Soc Trop Med Hyg 2001 95(4) 424-8. 

Spiramycin, which concentrates in placental tissue, is used to treat acute acquired toxoplasmosis in pregnancy to prevent transmission to the fetus. If fetal infection is detected, the combination of pyrimethamine and sulfadiazine is administered to the mother (only after the first 12-14 weeks of pregnancy) and to the newborn in the postnatal period. 

Pregnancy The pharmacokinetics of sulfadoxine and pyrimethamine 1500 -I- 75 mg have been studied in Papua New Guinea in 30 women in the second or third trimester of pregnancy and in 30 age-matched non-... 

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